Open AccessEffect of a Prior Portasystemic Shunt on Subsequent Liver Transplantation
Author(s) -
John J. Brems,
Jonathan R. Hiatt,
Andrew S. Klein,
J. Michael Millis,
John O. Colonna,
William J. Quiñones-Baldrich,
Kenneth P. Ramming,
Ronald W. Busuttil
Publication year - 1989
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198901000-00008
Subject(s) - medicine , portacaval shunt , shunt (medical) , surgery , liver transplantation , portal hypertension , transplantation , blood loss , gastroenterology , cirrhosis
Fifteen patients who had a prior portasystemic shunt underwent orthotopic liver transplantation. Shunt types were portacaval in six patients, H-graft mesocaval in six, distal splenorenal in two, and proximal splenorenal in one. Mean blood loss and hospital stay were highest in the portacaval group. Retransplants (two patients) and deaths (two patients) also were limited to this group. In this report, technical considerations, advantages, and disadvantages of the various shunt types are described. Management of patients with late stages of portal hypertension must include estimation of the effects of a portasystemic shunt on subsequent liver transplantation. It is concluded that portacaval shunts should be avoided in patients who may be considered for transplantation. Distal splenorenal shunts are best performed in younger patients with intractable variceal bleeding who are not expected to require transplantation in the near future. A mesocaval H-graft is the shunt of choice in patients who are current liver transplant candidates.